POSSIBILITIES AND LIMITS OF MEDICAL SCIENCE: DEBATES OVER DOUBLE‐BLIND CLINICAL TRIALS OF INTERCESSORY PRAYER

Abstract. This article traces the intellectual history of scientific studies of intercessory prayer published in English between 1965 and the present by focusing on the conflict and discussion they prompted in the medical literature. I analyze these debates with attention to how researchers articulate the possibilities and limits medical science has for studying intercessory prayer over time. I delineate three groups of researchers and commentators: those who think intercessory prayer can and should be studied scientifically, those who are more skeptical and articulate the limits of science around this topic, and those who focus primarily on the pragmatic applications of this knowledge. I analyze these contests as examples of what Thomas Gieryn calls “epistemic authority” as medical researchers engage in what he describes as “boundary‐work” or “the discursive attribution of selected qualities to scientists, scientific methods, and scientific claims for the purposes of drawing a rhetorical boundary between science and some less authoritative residual non‐science.” (Gieryn 1999, 4 (Gieryn 1999, 4)).     

Family Physicians’ Awareness and Knowledge of the Genetic Information Non-Discrimination Act (GINA)

Historically, physicians have expressed concern about their patients’ risk of genetic discrimination, which has acted as a barrier to uptake of genetic services. The Genetic Information Nondiscrimination Act of 2008 (GINA) is intended to protect patients against employer and health insurance discrimination. Physicians’ awareness and knowledge of GINA has yet to be evaluated. In 2009, we mailed surveys to 1500 randomly selected members of the American Academy of Family Physicians. Questions measured physicians’ current knowledge of GINA and their level of concern for genetic discrimination. In total, 401 physicians completed the survey (response rate 26.9%). Approximately half (54.5%) of physicians had no awareness of GINA. Of physicians who reported basic knowledge of GINA, the majority were aware of the protections offered for group health insurance (92.7%), private health insurance (82.9%), and employment (70.7%). Fewer physicians were aware of GINA’s limitations regarding life insurance (53.7%) and long-term care insurance (58.8%). Physicians demonstrated highest levels of concern for health insurance, life insurance, and long-term care insurance discrimination, with less concern for employer and family/social discrimination. Level of concern for the risk of genetic discrimination did not correlate significantly with awareness of GINA. Approximately 17 months after GINA was signed into federal law, physicians’ knowledge remained limited regarding the existence of this legislation and relevant details. Physicians who are aware of GINA continue to have significant concerns regarding the risk of genetic discrimination. This study reveals the need to further educate physicians about the existence of GINA and the protections offered.     

Essential Elements of Genetic Cancer Risk Assessment, Counseling, and Testing: Updated Recommendations of the National Society of Genetic Counselors

Updated from their original publication in 2004, these cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of counseling at-risk individuals through genetic cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Familial Cancer Risk Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Essential components include the intake, cancer risk assessment, genetic testing for an inherited cancer syndrome, informed consent, disclosure of genetic test results, and psychosocial assessment. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Young Adults with MSUD and Their Transition to Adulthood: Psychosocial Issues

Maple Syrup Urine Disease (MSUD) is an autosomal recessive condition with an incidence of 1 in 185,000 births worldwide. Regardless of the type of MSUD, treatment includes immediate and lifelong dietary restriction of isoleucine, leucine and valine. There is little known about the psychosocial impact of MSUD on the developmental milestones of emerging adulthood. We used a qualitative case study approach to explore the human experiences of MSUD on young adults (n?=?8) and parents (n?=?8). All participants were administered a semi-structured, qualitative interview as well as quantitative measures. Six core themes emerged: 1) lifelong strain of dietary management; 2) social isolation from peers and impact on dating; 3) impact of MSUD on academics and employment; 4) medical experiences and transition to adult care; 5) impact on family functioning; and 6) positive effects and growth. The results of this investigation highlight and expand awareness of the psychological and social needs of young adults with MSUD. This study calls for a collaborative, multidisciplinary effort in the treatment of these patients and their families.     

Psychosocial Functioning in Children and Adolescents with Extreme Obesity

The aim of this study was to investigate the psychosocial differences among obese pediatric patients, particularly those who are "extremely obese" as compared to "obese." Information was collected for 249 subjects at a multidisciplinary treatment clinic for obese youth. A battery of measures was administered and demographic data and height/weight was obtained. The results showed positive correlations between degree of obesity, psychosocial functioning, and quality of life. Specifically, the "extremely obese" were significantly more depressed, more socially anxious, and had poorer quality of life than the "obese" group. Girls and Caucasians were more socially anxious than boys and African Americans, respectively. There is mounting evidence that children and adolescents who are extremely obese are most at risk for psychiatric and medical disorders. Thus, targeting this group for assessment and/or designing treatment options specific for "extremely obese" youth is critical for the successful management of this population.     

Does theory of mind performance differ in children with early‐onset and regressive autism?

A deficit in theory of mind (ToM), or the ability to infer the mental states of others, has been implicated as one of the major characteristics of Autism Spectrum Disorder (ASD); however, little attention has been devoted to possible differences in ToM ability within ASD. The current study examined ToM performance in children with early-onset autism and regressive autism in comparison to typically developing children. Results indicated that children in the regressive autism group performed significantly better than the early-onset autism group on the non-verbal appearance-reality task. Additionally, Fisher's exact tests indicated a pattern of lowest scores in the early-onset group and highest scores in the typically developing group, whereas the regressive autism group tended to score in between the early-onset and typically developing groups. The apparent heterogeneity in ToM performance within ASD could account for the lack of universality in ToM ability found in previous studies.     

Chinese consumer ethnocentrism: A field experiment

Consumer ethnocentrism presents barriers for internationalising organisations. In China, evidence of a resurgent nationalism partly fuelled by rapid economic growth portends a shift in consumption away from foreign towards domestic products. On the other hand, rising consumer demand for branded and luxury products cannot be fully met domestically. However, much of the available evidence on Chinese consumer ethnocentrism is anecdotal and is based on attitudinal surveys that, as accurate measures of actual purchasing behaviour, suffer from certain methodological issues. In response, we report an experiment that measures the ethnocentrism of 447 Chinese consumers as their incentive‐compatible choices between foreign and domestic products in a field setting. Our findings show little effect of foreign origin on subjects' choices that were only weakly related with attitudinal measures including the commonly used consumer ethnocentric tendencies scale (CETSCALE). Our results question the existence of ethnocentric consumer behaviour in China and the use of CETSCALE to gauge it generally. Copyright © 2012 John Wiley & Sons, Ltd.     

Poisoning Severity Associated with a Range of Medications in Suicide Attempts by Ingestion

There are limited data on the medical severity of suicide attempts by intentional self‐poisoning (ISP) associated with ingestion of differing classes of medications and meager data on specific agents. The purpose of the study was to address these gaps. This was an analysis of a consecutive series of ISP cases ages 13 to 65 treated at a U.S. university medical center (N = 671). The outcome, poisoning severity, was dichotomized as “moderate‐severe” and “low” (reference) based on a standard measure. Class of medication (e.g., opiate) and specific agents ingested were the predictors of interest. Covariates were age, sex, and the ingestion of multiple classes of medications. Data were analyzed using multivariate logistic regression models. At the class level, ingestion of opiate was uniquely associated with increased risk for moderate‐severe ISP at a statistically significant level, adjusted odds ratio (95% CI) = 2.97 (1.69, 5.21), p = .0002. Several specific agents were also associated with moderate‐severe ISP. Along with the key role of opiate medications in unintentional overdose morbidity and mortality, opiate medications may also play an important and largely unrecognized role in medically serious suicidal behavior. Results also underscore the variability in toxicity of specific agents within drug classes.     

Elemental and Configural Processes in Patterning Discrimination Learning

Three experiments used appetitive conditioning with rats to examine the involvement of elemental and configural processes in positive and negative patterning discriminations. The first experiment demonstrated that negative and, to some extent, positive patterning discriminations were learned more rapidly when these discriminations consisted of stimulus elements that had previously been the reinforced as opposed to the non-reinforced elements of a simple discrimination. Experiment 2 revealed an excitatory summation effect during the early phase of negative patterning learning that depended upon discrimination pretraining. The final experiment demonstrated faster discrimination learning between the compound and the less salient, rather than the more salient, element of an instrumental patterning task. The present set of results were interpreted as reflecting the possibility, consistent with connectionist theory, that internal representations of the conditioned stimuli change over the course of a patterning discrimination.